The Influence of Aging on the Process of Accumulation: A Qualitative Study of Older Adults with Hoarding and Cluttering Behaviors

Individuals with hoarding and cluttering behaviors have difficulty discarding items, acquiring such a large number of items that their home environments become severely cluttered. Severe clutter interferes with activities of daily living and often causes distress to those living in the environment. Once viewed as personal lifestyle preferences, these behaviors are currently recognized as a mental health disorder associated with anxiety disorders and cognitive dysfunction. While hoarding and cluttering behaviors affect individuals of all ages, older adults are at increased risk of isolation, injury and other poor outcomes as a result of these behaviors. However, very little is currently known about the influence of age-related factors on hoarding and cluttering behaviors. To address this gap in our understanding, a qualitative study using Grounded Theory Methodology was conducted. Twenty-two adults age 65-91 with hoarding and cluttering behaviors were interviewed in their homes. Interviews were transcribed verbatim and analyzed using Atlas Ti software. All participants noted long-standing problems with hoarding and cluttering but narratives suggested how aging contributed to their current situation. Participants described a three-part process of accumulation that included acquiring, maintaining and discarding items. Patterns of behaviors emerged from data, describing two distinct "types" of individuals with hoarding behaviors. These two types, called Impulsive Acquirers and Anxious Keepers, differed in the ways in which they acquired, maintained, and discarded their belongings. In addition, participants described a dynamic interaction between the process of accumulation and aging. Changes in health status, social context, and home environment associated with aging generally contributed to worsening of the behaviors or outcomes, although some participants indicated that growing older increased their motivation to make changes in their home environments. By identifying these age-related factors and distinguishing the "type" of behaviors exhibited by older adults, clinicians will be able to develop more targeted interventions to reduce the risk of harm to older adults living in severely cluttered homes